Health and Economic Impact of Different Long-Term Oxygen Therapeutic Strategies in Patients with Chronic Respiratory Failure: A French Nationwide Health Claims Database (SNDS) Study

Abstract

Introduction: Long-term oxygen therapy (LTOT) is reported to improve survival in patients with chronic respiratory failure. We aimed to describe effectiveness, burden, and cost of illness of patients treated with portable oxygen concentrators (POC) compared to other LTOT options.

Methods: This retrospective comparative analysis included adult patients with chronic respiratory insufficiency and failure (CRF) upon a first delivery of LTOT between 2014 and 2019 and followed until December 2020, based on the French national healthcare database SNDS. Patients using POC, alone or in combination, were compared with patients using stationary concentrators alone (aSC), or compressed tanks (CTC) or liquid oxygen (LO2), matched on the basis of age, gender, comorbidities, and stationary concentrator use.

Results: Among 244,719 LTOT patients (mean age 75 ± 12, 48% women) included, 38% used aSC, 46% mobile oxygen in the form of LO2 (29%) and POC (18%), whereas 9% used CTC. The risk of death over the 72-month follow-up was estimated to be 13%, 15%, and 12% lower for patients in the POC group compared to aSC, CTC, and LO2, respectively. In the POC group yearly mean total costs per patient were 5% higher and 4% lower compared to aSC and CTC groups, respectively, and comparable in the LO2 group. The incremental cost-effectiveness ratio (ICER) of POC was €8895, €6288, and €13,152 per year of life gained compared to aSC, CTC, and LO2, respectively.

Conclusion: Within the POC group, we detected an association between higher mobility (POCs autonomy higher than 5 h), improved survival, lower costs, and ICER - €6 238, compared to lower mobility POCs users.

Keywords: Chronic obstructive pulmonary disease; Chronic respiratory failure; Cost-effectiveness; Long-term oxygen therapy; Portable oxygen concentrator; SNDS.

Fig. 1

Study flowchart of the population before matching. CTC compressed tanks, alone or in combination; LO2 liquid oxygen, alone or in combination; LTOT long-term oxygen therapy; POC portable oxygen concentrator, alone or in combination; aSC stationary concentrator, alone. All percentages are calculated using N = 244719 as denominator

Fig. 2

Venn diagram showing overlap between the main comorbid conditions known to be significantly associated with chronic respiratory insufficiencies and failure severity. This analysis was implemented to include patients with at least one comorbidity. Color coding is in accordance with the number of patients in each category of comorbid pathology, and within the Venn diagram the percentage of patients is reported

Fig. 3

Kaplan–Meier survival curves of overall survival analysis in patients with POC versus aSC. OS overall survival, CI confidence interval

Fig. 4

Kaplan–Meier survival curves of overall survival analysis in patients with POC versus CTC. OS overall survival, CI confidence interval

Fig. 5

Kaplan–Meier survival curves of overall survival analysis in patients with POC versus LO2

Fig. 6

Mean costs per patient per year and distribution by cost type in POC and aSC groups. OS overall survival, CI confidence interval

Fig. 7

Mean costs per patient per year and distribution by cost type in POC and CTC groups

Fig. 8

Mean costs per patient per year and distribution by cost type in POC and LO2 groups

Fig. 9

Kaplan–Meier survival curves of overall survival analysis in patients with HM POC versus LM POC. OS overall survival, CI confidence interval

Fig. 10

Mean costs per patient per year and distribution by cost type in POC HM and LM subpopulations